Supportive Care in Cancer

, Volume 17, Issue 10, pp 1311–1315

Retrospective evaluation of weekly paclitaxel hypersensitivity reactions reported utilizing an electronic medical record system at a tertiary cancer center

  • Lincy S. Lal
  • Donna L. Gerber
  • Jason Lau
  • William Dana
Original Article



This is a retrospective observational study evaluating hypersensitivity reactions captured by an electronic medical record (EMR) system for weekly paclitaxel infusions.

Materials and methods

The study evaluates the demographics, co-morbidities, premedications, chemotherapy agents, and postmedications of patients reporting a hypersensitivity reaction to weekly infusions of paclitaxel at a major cancer center, from June 2006 to December 2007. Data were analyzed using descriptive statistics and logistic regression. P values <0.05 were considered significant.


There were 51 hypersensitivity reactions in 36 patients during this time period that were documented in the allergy section of the EMR. Reactions occurred in patients with an average age of 55 years (SD = 10.77); 47 (92%) of the reactions occurred in females, and 42 (82%) of the reactions occurred with orders on the breast medical/surgical service. Thirty-two (63%) reactions occurred with either the first or second dose of weekly paclitaxel infusion. The most common premedication was dexamethasone (50 infusions), followed by diphenhydramine (18 infusions), and cimetidine (14 infusions). Thirty-three (65%) infusions had only one premedication. Postreaction, 41 (80%) cases had diphenhydramine and 30 (59%) cases had hydrocortisone administered prior to restarting the infusion. Logistic regression analysis did not indicate any relationship between history of previous allergies, hypertension, coronary disease, or chronic obstructive pulmonary disease and the number of premedications.


The results indicate that there is substantial variability in the type and number of premedications utilized in the management of paclitaxel hypersensitivity reactions. Interventions are needed to decrease the rate of hypersensitivity reactions from weekly paclitaxel infusions.


Hypersensitivity reactions Weekly paclitaxel Premedications 


  1. 1.
    Akerly W, Sikov WM, Cummings F et al (1997) Weekly high-dose paclitaxel in metastatic and locally advanced breast cancer. A preliminary report. Semin Oncol 24:87–90Google Scholar
  2. 2.
    Chang AY, Boros L, Asbury R et al (1997) Dose-escalation study of weekly 1-hour paclitaxel administration in patients with refractory cancers. Semin Oncol 24:69–71Google Scholar
  3. 3.
    Dyer AR, Stamler J, Berkson DM et al (1975) High blood-pressure: a risk factor for cancer mortality? Lancet 1:1051–1056. doi:10.1016/S0140-6736(75)91826-7 PubMedCrossRefGoogle Scholar
  4. 4.
    Goon PKY, Messerli FH, Lip GYH (2006) Hypertension and breast cancer: an association revisited? J Hum Hypertens 20:722–724. doi:10.1038/sj.jhh.1002053 PubMedCrossRefGoogle Scholar
  5. 5.
    Itoh Y, Sendo T, Hirakawa T et al (2004) Role of sensory nerve peptides rather than mast cell histamine in paclitaxel hypersensitivity. Am J Respir Crit Care Med 169:113–119. doi:10.1164/rccm.200307-901OC PubMedCrossRefGoogle Scholar
  6. 6.
    Lau DHM, Ryu J, Gandara D et al (1999) Concurrent twice weekly paclitaxel and thoracic irradiation for stage III non-small cell lung cancer. Semin Radiat Oncol 9:117–120PubMedGoogle Scholar
  7. 7.
    Lenz HJ (2007) Management and preparedness for infusion and hypersensitivity reactions. Oncologist 12:601–609. doi:10.1634/theoncologist.12-5-601 PubMedCrossRefGoogle Scholar
  8. 8.
    Milani A, DePas T, Noberasco C et al (2007) A 15-min premedication for 1-h paclitaxel infusion: optimizing patients’ care. Lung Cancer 58:300–301. doi:10.1016/j.lungcan.2007.08.009 PubMedCrossRefGoogle Scholar
  9. 9.
    National Cancer Institute (2006) Common terminology criteria for adverse events v3.0 (CTCAE). National Cancer Institute, BethesdaGoogle Scholar
  10. 10.
    Quock J, Dea G, Tanaka M et al (2002) Premedication strategy for weekly paclitaxel. Cancer Invest 20:666–672. doi:10.1081/CNV-120003535 PubMedCrossRefGoogle Scholar
  11. 11.
    Rowinsky EK, Onetto N, Canetta RM et al (1992) Taxol: the first of the taxanes, an important new class of antitumor agents. Semin Oncol 19:646–662PubMedGoogle Scholar
  12. 12.
    Ruiz-Casado A, Calzas J, Garcia J et al (2006) Life-threatening adverse drug reaction to paclitaxel. Postmarketing surveillance. Clin Transl Oncol 8:60–61. doi:10.1007/s12094-006-0098-5 PubMedCrossRefGoogle Scholar
  13. 13.
    Sparano JA, Wang M, Martino D et al (2008) Weekly paclitaxel in the adjuvant treatment of breast cancer. N Engl J Med 358:1663–671PubMedCrossRefGoogle Scholar
  14. 14.
    University of Texas M. D. Anderson (2008) Paclitaxel. Lexi-Comp ONLINE, HudsonGoogle Scholar
  15. 15.
    Weiss RB, Donehower RC, Wiernik PH et al (1990) Hypersensitivity reaction from taxol. J Clin Oncol 7:1263–1268Google Scholar
  16. 16.
    Zidan J, Hussein O, Abzah A et al (2008) Oral premedication for the prevention of hypersensitivity reactions to paclitaxel. Med Oncol 25:274–278PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Lincy S. Lal
    • 1
  • Donna L. Gerber
    • 2
  • Jason Lau
    • 1
  • William Dana
    • 3
  1. 1.Division of Pharmacy, Drug Use Policy and PharmacoeconomicsUniversity of Texas M. D. Anderson Cancer CenterHoustonUSA
  2. 2.Division of NursingUniversity of Texas M.D. Anderson Cancer CenterHoustonUSA
  3. 3.Pharmacy Programs, Division of Pharmacy, Drug Use Policy and PharmacoeconomicsUniversity of Texas M. D. Anderson Cancer CenterHoustonUSA

Personalised recommendations